Although there’s very little data on how pregnant and nursing mothers will respond to a COVID-19 vaccine, professional organizations (see links below) say the benefits are very likely to outweigh the risks. Pregnant women appear to have the same chance of catching COVID-19 as everyone else, but complications may be more prevalent.
According to a November study by the CDC, pregnant women are significantly more likely to be admitted to an intensive care unit for serious complications than women of the same age and health status who aren’t pregnant. Additionally, COVID-19 infection may also bring an increased risk of premature birth.
So far, none of the large clinical trials of vaccines have included pregnant or nursing mothers. Trials in pregnant women are expected to begin early next year.
Dr. Geeta Krishna Swamy, an OB/GYN at Duke Medical Center, who helped write the vaccine guidelines for the American College of Obstetricians and Gynecologists (ACOG) said data from both vaccines reassured her that unless a woman is able to isolate at home during her pregnancy, the known risks of catching COVID-19 probably outweigh the theoretical risk of vaccination. “The vaccine has been shown to be safe and is likely one of the most effective vaccines we’ve ever had.” In essence, based on what we already know about vaccines and pregnancy, there isn’t any reason to believe this vaccine is unsafe in pregnancy, but we do know that COVID-19 is unsafe in pregnancy.
Most people won’t have access to the vaccine for months and there will probably be more data by the time most pregnant women are able to receive it. But a large percentage of front-line health care workers are women of childbearing age and are confronting this decision now. Per Dr. Swamy: “I personally feel comfortable recommending to those women that your risk-benefit balance suggests you should get vaccinated. If a woman says I don’t want to get vaccinated, I think that’s absolutely, positively her choice, just like it’s her choice to get vaccinated.”
Swamy says she has even less concern about nursing mothers getting vaccinated. The Academy of Breastfeeding Medicine shares her comfort with the COVID-19 vaccine for breastfeeding women, writing in their new guidelines that a vaccine “would be unlikely to have any biological effects” on a breastfed infant. A woman who is vaccinated during pregnancy is likely to pass at least some protection on to her unborn child, with protection probably lasting some months after birth- breast milk probably provides even longer-lasting antibodies. According to Dr. Denise Jamieson, chief of gynecology and obstetrics for Emory Healthcare in Atlanta, COVID-19 is unlikely to pass through breast milk. And per CDC: “There are no data on the safety of COVID-19 vaccines in lactating women or on the effects of mRNA vaccines on the breastfed infant or on milk production/excretion. mRNA vaccines are not thought to be a risk to the breastfeeding infant. People who are breastfeeding and are part of a group recommended to receive a COVID-19 vaccine, such as healthcare personnel, may choose to be vaccinated.”
ACOG guidelines state that in the absence of specific data, a pregnant woman should make an individual decision about whether to get vaccinated.
Two key quotes:
- “ACOG recommends that COVID-19 vaccines should not be withheld from pregnant individuals who meet criteria for vaccination based on ACIP-recommended priority groups.”
- “COVID-19 vaccines should be offered to lactating individuals similar to non-lactating individuals when they meet criteria for receipt of the vaccine based on prioritization groups outlined by the ACIP.” (Advisory Committee on Immunization Practices)
The Society for Maternal Fetal Medicine (SMFM) also put out a statement: https://s3.amazonaws.com/cdn.smfm.org/media/2591/SMFM_Vaccine_Statement_12-1-20_(final).pdf Key quote:
- “SMFM recommends that healthcare workers, who are considered prioritized for vaccination, be offered the vaccine if pregnant. A report by the National Academies of Sciences, Engineering, and Medicine entitled Framework for Equitable Allocation of COVID-19 Vaccine recommends that high-risk workers in health facilities or first responders should be among the first to receive the vaccine. Although pregnant women are not explicitly targeted in this framework, pregnant and lactating women who are otherwise eligible should be offered the vaccine.”
CDC: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/pregnancy.html. CDC essentially endorses shared decision making between the pregnant healthcare worker and her provider. They also note the higher risks of severe COVID-19 illness in pregnant people. They do not recommend pregnancy testing before administration, and state that people who are trying to conceive do not need to hold off until after vaccination. They go on to state:
- “While studies have not yet been done, based on how mRNA vaccines work, experts believe they are unlikely to pose a risk for people who are pregnant. mRNA vaccines do not contain the live virus that causes COVID-19 and therefore cannot give someone COVID-19. Additionally, mRNA vaccines do not interact with genetic material DNA because the mRNA does not enter the nucleus of the cell; cells break apart the mRNA quickly. However, the potential risks of mRNA vaccines to the pregnant person and her fetus are unknown because these vaccines have not been studied in pregnant women.”